Chemotherapy use and outcomes in patients with stage III or IV small-cell lung cancer in relation to age: An analysis of the English Systemic Anti-Cancer Treatment (SACT) dataset

Abstract

Introduction: Survival from small cell lung cancer (SCLC) is poor and there has been little progress in treatment. There is little evidence on outcomes in patients aged 75+. We described patterns of chemotherapy use and outcomes using the national Systemic Anti-Cancer Treatment dataset in patients with stage III or IV SCLC in relation to age. Method: We included 7,966 SCLC (67.6% stage IV) diagnosed between 2014-17 in England, treated with chemotherapy and followed up through 2017. Patterns of chemotherapy use, 30- and 90- mortality rates, 6-,12-month and median overall survival (OS) from the start of the first chemotherapy cycle were compared between those below and above the age of 75. OS was estimated using Kaplan Meier estimator and modeled using a flexible hazard regression model. Results: Older patients were 6-7 times less likely to receive curative treatment than younger patients regardless of stage. There were more frequent adjustments of treatment and dose reduction (stage III) in older than younger patients but no age-related differences in reduction of doses (stage IV), treatment delayed or stopped earlier than planned. Although 30-day mortality rates were similar across age groups in stage III SCLC (≈ 4%), older patients had higher early mortality and poorer OS than younger peers. In both stages, 6 and 12-month OS by age decreased around the age of 70-75 and were worse in patients with performance status scores ≥2. Conclusion: This study offers a snapshot of chemotherapy use and outcomes in advanced SCLC, notably in older patients, in the pre-immunotherapy era.